Method and device for treating urinary incontinence

ABSTRACT

A method for treating urinary incontinence includes making an incision in a region adjacent to the urethra, and positioning a tape under the urethra through the incision such that one portion of the tape extends from under the urethra through one obturator foramen and another portion of the tape extends from under urethra through the other obturator foramen.

The invention relates to a method for treating urinary incontinence inwomen. It also relates to an implantable device intended to correcturinary incontinence in women. The said device is more particularlysuited to the treatment of stress urinary incontinence.

Various types of device have been proposed for treating phenomena ofurinary incontinence in women.

Thus, for example, document U.S. Pat. No. 5,899,909 describes a tape ofconstant width, made of a material of the meshed or knittedpolypropylene type ensuring fibroblast colonization and thus anchorageinto the tissues along its entire length. Once an incision has been madein the wall of the vagina this tape is positioned under the urethra, thetape being led upwards on each side of the bladder to be anchored intothe abdominal wall.

The method of fitting this tape is relatively tricky. Specifically, theneedles being led vertically up alongside the bladder may not onlypierce the latter, but may above all pierce the iliac artery or even thesmall intestine. In consequence, it is essential that cystoscopy beperformed during the intervention.

Document WO 98/35632 describes a device in the form of a tape, thecentral region of which is wider than the body of the tape, the assemblybeing made of a biocompatible material, particularly a woven material,flowing for fibroblast colonization.

As before, each of the ends of the tape is led up alongside the bladderto be secured at the abdominal wall or, more specifically, in the boneof the pubis. Thus, the same drawbacks as before may be encountered.

One of the objects of the invention is to artificially reconstruct thepelvic fascia by fitting tapes aimed at restoring, as faithfully aspossible, the effective and natural situation of the endo-pelvic fascia,in its role of fibrous plug obturating the uro-genital opening, the saidfascia resting on either side of the said opening on the floor of thelifting muscles.

Another of the stated objects of the present invention lies in solvingthe problems associated with subsequent surgical re-intervention in theregion of the urethra; given the fact that the tapes proposed by thePrior Art are made, along their entire length, of a material capable ofbeing colonized by fibroblasts, the problem arises of performing anintervention in this region if the tape, because of the fibroblastcolonization, is anchored to the periurethral wall. A solution to thisnew problem is all the more important now that it has been found thatthe phenomenon of urinary incontinence may evolve to the fitting of anartificial sphincter. A problem such as this is neither disclosed norsuggested in the Prior Art.

Furthermore, the literature has described possible phenomena of themigration of the substance of which the tape is made, particularlypolypropylene, into the viscera

In order to solve all of these problems, the Applicant is proposing amethod and an implantable device, intended to correct urinaryincontinence in women.

This method for treating urinary incontinence in women comprises thefollowing steps:

-   -   making a mediane paraurethral incision, practically in the        middle third of the urethra, measured from the meatus, so as to        allow the passage of a tape between the Alban fascia and the        periurethral fascias;    -   extending each of the free ends of the said tape in the region        of the two obturator foramen of the iliac wing and leading them        out into the groin opposite the corresponding foramen so that        they essentially form a V shape, the point of which V passes        under the urethra without changing the position thereof.

In other words, and contrary to the surgical techniques employed in thestate of the art, the tape is not led up alongside the bladder to form aU and thus be situated in close proximity to vital organs, but is on thecontrary diverted from the bladder to form a V. Hence, no risk ofdamaging the bladder, the iliac artery or the small intestine is run. Inconsequence, it is not necessary to perform cystoscopy during theintervention.

According to the invention, in order to make it easier to fit the tapewhich acts as an implant, a space is made between, on the one hand, theAlban fascia, the perineal muscular plane and the anterior insertion ofthe puborectal muscle and, on the other hand, the periurethral fascias.

According to an advantageous version of the invention, the centralregion of the tape or implant, which region is intended to be insertedbetween the Alban fascia and the periurethral fascias, is coated with asubstance capable of preventing any adhesion of the said fascias to thetape.

Thus it becomes possible to avoid any cell growth on the tape betweenthe wall of the vagina and the wall of the urethra, hence avoiding anyanchorage of the tape in this region and thus to allow subsequentsurgical re-intervention. Furthermore, coating it with such a substancein the region of the urethra makes it possible to avoid any migration ofpolypropylene into the viscera.

The device according to the invention is characterized in that it is inthe form of a tape of which the central region, intended to be insertedbetween the Alban fascia and the periurethral fascia, is coated with asubstance capable of preventing any adhesion of the said fascias to thetape.

In a first embodiment, the substance that prevents adhesion of thefascias to the tape is silicone.

In a second embodiment, the substance is made of vegetable or animalgrowth factors.

Of course, any substance capable of avoiding the adhesion of the fasciasto the tape may be envisaged.

The tape is coated on both side, advantageously on one side.

Furthermore, the tape is made of any materials such as those known tothose skilled in the art and, in particular but without applying anylimitation, any material chosen from the group containing polyethyleneand polypropylene.

According to another feature, when the tape is made of polypropylene,the polypropylene is either meshed or knitted or alternatively is in theform of sprayed fibres. Nevetheless, the tape can also be made ofabsorbable material.

In one advantageous embodiment, the central region of the tape is not aswide as the rest of the tape and this is so as to limit the area ofcontact in the region of the Alban fascia and of the periurethralfascia.

Furthermore, and according to another feature, each of the ends of thetape has a tapered point intended to be anchored in the groin facing thecorresponding obturator foramen.

According to a preferred embodiment, the tape has a length equal to 60cm and a width equal to 2.5 cm, and has a central region which is not aswide, being 1 cm wide over a length equal to 3 cm. Advantageously, thecentral region has a length equal to 15 mm.

The invention and its ensuing advantages will emerge better from thefollowing example in support of the appended figures.

FIG. 1 is a diagrammatic depiction of the tape of the invention.

FIG. 2 is a diagrammatic depiction of the position of the tape afterfitting.

As shown in FIG. 1, the device of the invention is in the form of a tape(1) of a length equal to 60 cm and of a width equal to 2.5 cm. This tapeis made, along its entire length, of sprayed polypropylene fibres.

According to an advantageous feature, the tape has, at its centre (2), anarrowing of length equal to 3 cm and of width equal to 1 cm, thisportion being coated on both sides with a silicone-containing substance.Furthermore, each of its free ends (3, 4) is tapered.

Fitting the device requires mini-invasive surgery, the main steps ofwhich are described hereinafter.

First of all, a mediane paraurethral incision is made in the region ofthe middle third of the urethra.

One of the two obturator foramen, and more specifically the lowerinternal part is then identified by a finger slipped into the vaginalincision and an incision is made in the perineal skin opposite it, andso in the groin, so as to form an orifice through which an Emmet needleis then passed. This needle is introduced through this cutaneousincision firstly perpendicular to the perineum for about 15 mm (passingthrough the internal obturator muscle as far as just outside theischiopubic branch), then the needle is allowed to describe itscurvature, guided in this by the finger introduced opposite theobturator muscle through the vaginal incision. The pointed end of thetape is then slipped into the eye of the needle, emerging from the saidvaginal incision, then pulled back through the thickness of muscle, theretractor and the internal obturator up to the surface of the skin.

The tape is then placed between the Alban fascia and the periurethralfascias to position it in such a way that its central region, coatedwith silicone as appropriate, faces the said fascias. The tape ispositioned without pulling behind the urethra.

An incision is then made in the perineal skin facing the secondobturator foramen, into which incision an Emmet needle is inserted. Thefree end of the tape is then slipped into the eye of the needle which ispulled back in the same way as before.

The excess tape is then cut off flush with the skin then the skin isimmobilized to disconnect it from the tape. The incision is finallyclosed with a stitch of quickly absorbable suture.

FIG. 2 diagrammatically depicts the position, in cross section, of thetape after it has been fitted. As shown in this figure, once in place,the tape adopts the shape of a V, the branches of which are very farapart.

Furthermore, it can also be seen that when the tape according to one ofthe advantageous embodiments of the invention is used, thesilicone-coated segment of the tape is positioned between the uterus (5)and the vagina (6), while its ends (3, 4) are secured in the region ofthe groin (7, 8) facing the obturator foramen.

Thanks to the robustness and texture of the tape, tension can be strongwithout there being any risk of rupture. The tape is positioned underthe control of sight without employing cystoscopy. It is essential thatthere be no pulling on this tape which has to be slipped down under theurethra without altering the position thereof.

It is apparent from the foregoing that the method according to theinvention for treating urinary incontinence in women differs from themethods proposed in the state of the art through the simplicity offitting of the tape, using mini-invasive surgery. Furthermore, itprovides the urethra with firm suspension while at the same timemaintaining a certain degree of flexibility and, most of all, keepingthe vital organs in the vicinity relatively far away from the said tape.Furthermore, it plays a part in reconstructing the endopelvic fascia.

1. A method of treating urinary incontinence, the method comprising:making an incision proximate a urethra of a patient; inserting at leasta portion of an implant comprising mesh into the incision; extending afirst end of the implant through a first obturator foramen, andextending a second end of the implant through a second obturator foramensuch that the first and second ends of the implant are each divertedaway from a bladder of the patient.
 2. The method of claim 1, whereinthe first and second ends of the implant are each diverted away from thebladder of the patient such that a portion of the implant forms aV-shape, and a point of the V-shape is located inferior the urethra. 3.The method of claim 1, further comprising: extending the first end ofthe implant through the first obturator foramen and leading the firstend out of a groin proximate the first foramen, and extending the secondend of the implant through the second obturator foramen and leading thesecond end out of the groin proximate the second foramen.
 4. The methodof claim 1, wherein the mesh comprises a knitted polypropylene mesh. 5.The method of claim 1, wherein the mesh comprises a polypropylene mesh.